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Safety board wants new medical helicopter rules

/ Source: The Associated Press

The National Transportation Safety Board approved recommendations Tuesday for better training and sophisticated safety equipment for emergency helicopter operators, and wants to limit Medicare payments for medical flights to operators who meet new safety standards.

The NTSB recommendations urge the Federal Aviation Administration to, among other things, require medical helicopter operators to install autopilot systems that can help solo pilots, terrain awareness monitoring to help pilots navigate in bad conditions, night-vision systems that help navigate in the dark and flight data recorders.

The safety board, which cannot require such rules, also wants the FAA to require medical helicopter pilots to receive safety training and to report flight activity at least annually.

The board also agreed to ask the Department of Health and Human Services to create safety audits for emergency helicopter operators and to require the operators to pass the new safety standards to receive Medicare payments for medical flights. Board members approved the concept Tuesday at their meeting and asked NTSB staff to craft recommendations to send to HHS, which would have to adopt the changes in reimbursements.

The move to tie Medicare reimbursements to safety standards is a new approach by the NTSB, although the board has recommended linking improvements to accreditation for other industries in the past, NTSB Chairman Deborah Hersman said.

"We've seen that approach as a useful model in other industries," she said.

Record number of people killed

The board's action comes after last year's record number of fatalities involving emergency medical helicopters. There were nine accidents between December 2007 and October 2008, killing 35 people. No fatalities were reported in the three accidents since then.

The spike in accidents follows extraordinary growth in the number of emergency medical helicopters operating throughout the country. The number of operators increased more than 80 percent over the past 10 years, with about 750 medical service helicopters offering service today.

Yet medical helicopters are permitted to operate without basic safety features that commercial flights must carry, such as black box recorders, collision-avoidance systems and radar altimeters.

NTSB board members said they believe changes in Medicare reimbursement rules in 2002 made it easier for helicopter operators to receive reimbursement for emergency medical flights. And those changes led to the large increase in providers.

NTSB board member Robert Sumwalt, who proposed linking Medicare reimbursement to new safety audits, said regulators have to take bold steps to improve standards and HHS officials can provide an incentive.

"I feel that we do have to push the envelope," Sumwalt said.

The safety board already has urged FAA to toughen regulations for emergency helicopter operators, although Hersman and others have argued that FAA hasn't moved quickly enough. In 2006, NTSB recommended installation of terrain awareness systems, adoption of formal flight risk assessments before EMS flights, and new EMS flight dispatch procedures that include up-to-date weather information and assistance in flight risk decisions.

FAA spokesman Les Dorr said Tuesday those recommendations and more approved Tuesday by NTSB will be considered as FAA develops new rules for emergency helicopters. Those proposals are due early next year, Dorr said.